USMLE题库Cardiology(二)11-20.pptx

Cardiology 2 题库 Q 11 A 34-year-old Caucasian female who is being evaluated for proteinuria and a facial rash complains of chest pain. The pain is sharp in quality and increases with inspiration. It radiates to the trapezius ridge and is partially relieved by sitting up. Which of the following is the most likely cause of this patient’s chest pain? Intimal hyperplasia of pulmonary arteries Aortic dissection Pericardial inflammation Non-infectious cardiac valve vegetations Cardiac tamponade A 11 Correct answer: C The patient described above displays symptoms of systemic lupus erythematosus (SLE). This chronic autoimmune disease affects predominantly women 20 - 40 years of age and presents with a malar facial rash, photosensitivity with exacerbation of cutaneous disease after sun exposure, and arthralgias. Constitutional symptoms such as low-grade fever, malaise and weight loss are common. Renal involvement is present in virtually all patients with SLE, although it may be asymptomatic at the beginning of the disease. In the patient described in this clinical vignette, proteinuria is evidence of lupus nephritis. Inflammation of the serous membranes is another common manifestation of SLE. Fibrinous exudation is typical for acute serositis caused by SLE, while chronic inflammation leads to fibrosis and possible obliteration of serous cavity. SLE-associated serosal inflammation can cause pleuritis and pericarditis. Pericarditis occurs commonly in patients with SLE; at least half of patients with SLE will experience this complication during their lifetimes. Pericarditis manifests with severe and constant middle or left chest pain that may radiate to the back, arms and shoulders. The pain increases on inspiration (pleuritic) and is relieved by sitting up and leaning forward (postural). Auscultation of the chest reveals a scratchy sound called a pericardial friction rub that is best heard with the patient sitting upright and leaning forward. (Choice A) Intimal hyperplasia of